When the Mission Is Suicide
The professor shocked me. We were sitting in my office chatting during a routine visit. After a thorough physical and laboratory examination, I had found no evidence that his colon cancer, removed a year earlier, had recurred. As I looked at his stout, muscular frame, piercing black eyes and halo of white hair, I wondered if I’d be so fit at 86. He was the picture of health.
And then the professor asked me for a lethal dose of barbiturates. If my tumor ever relapses, he said, I want to end my life on my terms, when and where I choose.
I sat for a moment, mind racing. The professor, a brilliant chemist once nominated for the Nobel Prize, was one of my favorite patients and a close friend. His cancer was clearly in remission, so he was not in any immediate danger. Was he overwhelmed by caring for his wife, who was slowly dying from Alzheimer’s disease? Did he really want the sedatives for her?
As always, the professor was one step ahead. He reassured me that he wasn’t planning to kill his wife, and was not depressed. I just don’t want to fade away like Hanna, he said. The drugs would be his insurance policy.
According to recent surveys, the professor was not alone in his desires. More than half of all Americans support a right to die, according to some polls. And many doctors agree. Ten percent of oncologists in the United States have actually participated in the suicide of a patient.
But why do patients wish to pursue physician-assisted suicide (in which a doctor supplies the medicines but the patient kills himself) or euthanasia (in which the doctor directly administers medication)? Why was Dr. Kevorkian so popular? Why has mercy killing become such a hot-button national issue?
The debate’s roots are as old as the healing profession. Hippocrates, in his famous oath, counseled doctors to give no deadly medicines to anyone if asked. For more than two millennia the physician stood as the guardian of life, prevented by legal and professional codes from hastening death. But in the last two decades tradition has been under attack.
Proponents of mercy killing point to the doctor’s duty to relieve suffering by any means possible. In the words of the Hemlock Society, everyone should have the option of a peaceful, gentle, certain and swift death in the company of loved ones. Modern technology, the argument runs, may keep us alive longer, but it often does not ensure an acceptable quality of life.
Opponents cite religious beliefs and the physician’s fundamental role as healer, not agent of death. They fear erosion of the trust essential for the doctor-patient relationship, and worry that legalized mercy killing will lead to abuses. Who will protect the poor, the infirm, the elderly?
The controversy is no longer theoretical. In 1997, Oregon legalized physician-assisted suicide. Since then, 70 people dying from cancer, neurological disorders or heart disease have elected to swallow an overdose of sedatives there. The reasons they gave for doing so ranged from a fear of pain to worries about being a financial burden on their families.
But these factors were dwarfed by another concern: loss of control. The Oregonians who committed suicide wished to preserve mental and bodily functions to the end. To them, a self-inflicted death was more dignified than letting nature take its unpredictable course.
The professor taught me just how important this sense of control can be.
On principle, I refused to honor his request for a lethal dose of sedatives.
A year later his cancer returned, quickly causing severe jaundice and weight loss. To compound the catastrophe, Hanna had died a few months earlier. The professor, satisfied that he had lived his life to the fullest, enrolled in a home hospice program.
Thus began the most memorable house call of my career. One evening I drove up the steep canyon street to the professor’s home. As I rounded the final curve I noticed an empty LAPD car parked in the driveway, lights flashing. The front door to the house was open. I stepped inside to find the professor arguing furiously with an officer.
“No, I will not give you the gun!” the professor screamed. “You have no right to take it.”
“Actually, I do have that right,” the officer evenly replied. “You threatened to kill yourself and your nurse, and I can’t leave until I have the gun.”
I quickly learned the professor intended to shoot himself. His plans were thwarted when his nurse overheard him muttering to himself and called the police.
Back and forth the argument went. At first the professor refused to divulge the location of the gun, but after being threatened with arrest he finally relented.
He told the officer the gun was on his bookshelf, tucked in the hollowed-out pages of an old text. A few minutes later the patrolman left, an impounded Smith & Wesson in one hand and six bullets in the other.
The professor refused to look at me. “You’ve taken everything,” he said flatly, gaze averted.
I felt unbearably sad, crushed that things had come to such a ludicrous conclusion. Unbidden, tears began to slide down my cheeks. “Would you like me to ask another doctor to care for you, professor? I know an oncologist who will cooperate with your plans.”
“Do not cry, Dr. Reese. You do not have to kill me. I am resigned.”
I never had a chance to speak with my friend again. Two days later the professor drifted into a deep sleep and quietly passed away.
Given the prominence of the right-do-die movement, I will certainly be asked again to assist in a patient’s suicide. I will think of the professor and I wonder what I will say.
